The Pillars of a Sustainable Hospital-at-Home Model

A successful hospital-at-home initiative rests on three core pillars: identifying alternative care settings, securing a predictable revenue stream, and cultivating unwavering support from hospital administrators. These elements, according to Dr. Jeremy Boal, co-founder of the Mount Sinai Visiting Doctor Program and former chief clinical officer of the Mount Sinai Health System, are not merely desirable, but essential for long-term viability.

Dr. Boal emphasizes that gaining leadership support is often the most significant hurdle. He advocates for a shift in perspective, urging clinical leaders to understand the priorities and concerns of those in executive positions. “Part of the art of driving change is determining the prevailing conversation among leadership,” he stated during a keynote address at the Hospital at Home Users Group annual meeting.

Navigating Leadership Concerns

Mount Sinai Health System, a sprawling network encompassing 43,000 employees, 400 outpatient practices, and nearly 300 labs, provides a compelling case study. Their Mount Sinai at Home program, initially launched in 2014 with a CMS Innovation Center grant, demonstrates the power of adaptability. When the grant funding concluded, the program transitioned to a sustainable model fueled by various payers, including Medicare Advantage.

Dr. Boal highlights that leadership concerns are fluid. Sometimes, the focus is on maximizing bed occupancy; at other times, it’s about staying ahead of competitors or providing cutting-edge training opportunities for medical residents. Understanding these shifting priorities is paramount. What challenges are *your* hospital leaders currently prioritizing, and how could a hospital-at-home program address them?

Mount Sinai’s strategic partnership with Contessa Health further illustrates their commitment to a comprehensive, home-based care continuum. This collaboration underscores the value of external expertise in building a robust program.

The Power of Narrative and Data

Clinical leaders must be prepared to articulate the benefits of hospital-at-home programs concisely and persuasively. Executives, often pressed for time, need to quickly grasp how these programs solve problems or unlock new opportunities. Dr. Boal stresses the importance of storytelling. “The most powerful tool we have for building will is narrative… if we can get really good at telling stories, specific stories, about specific patients, and linking that also to the business case, I think we can really move hearts and minds.”

Beyond compelling narratives, a strong business case is crucial. Demonstrating cost savings, improved patient outcomes, and increased patient satisfaction are all vital components of securing and maintaining leadership support.

Leveraging Existing Resources

Hospitals don’t need to build a hospital-at-home program from scratch. Home health and hospice agencies possess invaluable expertise in providing care within the home setting. Dr. Boal emphasizes the importance of tapping into this existing knowledge base. Are you actively collaborating with local home health agencies to inform your hospital-at-home strategy?

Navigating Regulatory Hurdles and Future Outlook

Recent government shutdowns have highlighted the fragility of certain hospital-at-home initiatives. The lapse of the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care At Home program, initially launched in 2020 as a pandemic response (CMS waiver program), underscores the need for advocacy and proactive planning. The temporary suspension of telehealth flexibilities further complicates the landscape.

Despite these challenges, Dr. Boal remains optimistic. He believes that every market should have access to a hospital-at-home program within the next decade. “If we look 10 years forward, wouldn’t it be amazing… if you only had to come to the hospital if the hospital-at-home infrastructure wasn’t enough to keep you well, but you had access to it for everything else?”

Frequently Asked Questions About Hospital-at-Home Programs

• What is the biggest challenge in implementing a hospital-at-home program?

  Securing consistent support from hospital leadership is often the most significant obstacle. Understanding their priorities and addressing their concerns is crucial for success.

• How can a hospital demonstrate the value of a hospital-at-home program to leadership?

  Presenting a compelling business case with quantifiable data on cost savings, improved patient outcomes, and increased patient satisfaction is essential.

• What role do home health agencies play in developing a hospital-at-home program?

  Home health and hospice agencies possess valuable expertise in providing care within the home setting and can serve as a key source of knowledge and support.

• How does the CMS Acute Hospital Care At Home program impact hospital-at-home initiatives?

  The CMS waiver program provides reimbursement for delivering hospital-level care in the home, but its stability can be affected by government shutdowns and policy changes.

• What is the long-term vision for hospital-at-home programs?

  The ultimate goal is to make hospital-at-home care accessible in every market, reserving traditional hospital stays for cases requiring specialized infrastructure.